By the numbers: How community pharmacists measure up

How do the nation’s pharmacists rate with Americans? According to Gallup, the answer is very, very high year after year.

Each year, Gallup researchers conduct a national poll to gauge Americans’ level of trust in the people engaged in a wide variety of professions, from doctors and police officers to business leaders and educators. And community pharmacists consistently rank at or near the top of the most trusted professionals.

In the latest Gallup Honesty and Integrity survey, released in December, Americans rated pharmacists second in terms of trustworthiness and ethical standards, behind only nurses and tied with medical doctors. That marks the 12th straight year in which pharmacists ranked in the top three of all professionals for trust and integrity.

“The survey results reflect the remarkable trust that patients continue to place in their pharmacists, and for strong and important reasons,” said National Association of Chain Drug Stores president and CEO Steve Anderson. “Pharmacists are highly educated and highly accessible professionals within the healthcare delivery system. They are highly valued in neighborhoods across America, and particularly by those in the greatest need.”

Americans also rank pharmacists high in terms of helpfulness and their contributions to overall health and wellbeing. A national survey of likely voters engaged and aware of current events, conducted on behalf of NACDS in 2014, confirmed that Americans rely on their local pharmacist not only for counseling on their health and medication use, but for advice on over-the-counter medicines.

“We asked … if people did various things in a pharmacy over the past 12 months,” Anderson said. “About half spoke [with] a pharmacist about a prescription drug. And pretty much the same percentage spoke to a pharmacist about an over-the-counter product. More than 7-in-10 said a pharmacist’s recommendation on an OTC [product] is important to them.”

What’s more, Anderson said, “3-in-10 spoke to a pharmacist about a personal health question. And — in a powerful statement about the relationship between the pharmacy and the front end — more than half said they purchased food or groceries at a pharmacy.”

“We used to debate about what to call pharmacy patrons: were they patients, [or] were they consumers? I think we can consider that debate closed. They are both patients and consumers,” Anderson said.

The overall contributions to Americans’ health and wellbeing made by pharmacists — not only in the vital medications they dispense but also in the counseling and preventive care services they provide — are almost impossible to overstate. As “the face of neighborhood health care,” community pharmacists often represent the final link in the chain of care that extends from health providers to patients, and they’re unquestionably the most accessible health professional available to the nation’s 320 million people.

Roughly 9-out-of-10 Americans live within five miles of a community pharmacy, according to NACDS research. For those living in metropolitan areas, the average distance shrinks to 1.83 miles.

Besides being within easy reach of the vast majority of the population, the community pharmacy industry is one of the nation’s biggest sources of employment. Independently owned pharmacies remain strong, with some 23,000 locations nationwide. Chains, including traditional drug stores and supermarkets, as well as mass merchants with pharmacies, operate more than 40,000 pharmacies and employ more than 3.8 million individuals, including 175,000 pharmacists. They fill more than 2.7 billion prescriptions yearly and help patients use medicines correctly and safely, while offering innovative services that improve patient health and healthcare affordability.

NACDS’ 125 chain members span a diverse array of companies, from regional chains with a minimum of four stores up to the largest national pharmacy retailers. NACDS members also include more than 800 supplier partners and nearly 40 international members representing 13 countries.

The widespread expansion of community pharmacy to most Americans has put medication therapy and disease management services, immunizations, health screenings and other personalized patient-care services — not to mention vital prescription medicines and counseling on their use — within easy reach of most Americans. That proximity of health professionals and medications is a big strand in the web of steadily improving health care that helped boost the nation’s average longevity rate by some 30 years in the 20th century.

THE NUMBERS

Survey: How Americans rely on pharmacists

According to a recent 12-month national survey:

50% of respondents spoke to a pharmacist about a question they had about a prescription medication at a pharmacy;

47% of respondents spoke to a pharmacist about a question they had about an over-the-counter medication at a pharmacy;

29% of respondents spoke to a pharmacist about a question they had about a personal health question at a pharmacy; and

Patient access, lower costs, accountability and collaborative care: those are the watchwords that define the nation’s overextended web of health care in 2015. And community pharmacy — the true face of neighborhood health care — offers some timely solutions to all of them.

The U.S. health system is grappling with a daunting list of challenges as it lurches through a massive transformation to a more accountable, cost-effective and rational system of care. Among the most pressing of those challenges: the still-rising $2.5 trillion annual healthcare bill, which now consumes roughly 18% of the GDP; an acute and growing shortage of primary care physicians that makes it tougher for patients to gain access to health services on a timely basis; and the growing strain on federal and state health resources as aging boomers and newly insured Americans rapidly swell the ranks of Medicare and Medicaid.

Amid those hurdles, pharmacists remain the most underutilized network of health professionals in the United States. This despite the fact that the pharmacy profession has undergone a remarkable transformation over the past two decades, and is poised to offer new and innovative solutions to some of the nation’s most urgent healthcare issues.

It’s a glaring disconnect. Even as pharmacists dramatically expand their clinical and preventive-health expertise and provide more patient-care services that improve the health and wellbeing of Americans — while lowering the costs of care for public and private health plans — the healthcare delivery system and government policies have not yet adapted sufficiently to maximize pharmacy’s pro-patient impact.

Yet, pharmacy operators continue to pursue an expanded practice model, offering a more cost-effective alternative for a growing list of frontline health-and-wellness services. “We’re looking for anything we can do to expand our outreach into the community and supplement the primary healthcare providers,” said Dennis Wiesner, senior director of privacy, pharmacy and government affairs for San Antonio-based H-E-B and VP of the Texas State Board of Pharmacy.

“Pharmacists are helping to shape the healthcare delivery system of tomorrow — in partnership with doctors, nurses and others,” said Steve Anderson, president and CEO of the National Association of Chain Drug Stores. “This collaboration with other healthcare team members can lead to better health outcomes for the ultimate good of the patient. As one of the most trusted healthcare professionals, and arguably the most accessible healthcare professionals, pharmacists are uniquely positioned to provide services to patients, particularly among those in under-served communities where healthcare may not be readily available,” Anderson added.

Focusing on successful outcomes

The core of pharmacy practice remains the expert dispensing and management of prescription drugs — and the counseling and medication therapy management that pharmacists provide at tens of thousands of community pharmacies every day.

It’s a critical part of healthcare delivery. An estimated 82% of Americans use daily medications to manage their health, and 29% take five or more medications, according to the Centers for Disease Control and Prevention. Chain pharmacies alone, Anderson pointed out, “fill over 2.7 billion prescriptions yearly and help patients use medicines correctly and safely, while offering innovative services that improve patient health and healthcare affordability.”

For the nation’s health system as a whole, the move to allow pharmacists to provide state-approved health services to underserved Medicare beneficiaries couldn’t come at a better time. Pharmacists are tapping more of their full potential, meeting the needs of patients in new and exciting ways as they integrate services like immunizations, health screenings, medication therapy management, and diabetes management with the activities of other health providers in collaborative care models and accountable care organizations.

“Our product used to be dispensing pills safely and efficiently, but today our product is that and much more,” said Greg Wasson, recently retired president and CEO of Walgreens Boots Alliance. “Our product is an outcome — an improved health outcome — that only a face-to-face encounter with a community pharmacist can accomplish.”

It’s about telling pharmacy’s story and demonstrating the pharmacy profession’s value “one consultation, one vaccination, one medication synchronization, and one screening at a time,” Anderson noted. “The American public will be the beneficiaries of greater efforts to realize the potential of pharmacies as the ‘face of neighborhood health care.’”

Consider some recent examples:

Rite Aid’s Health Alliance leverages the combined expertise of community pharmacists and in-store care coaches in collaboration with physicians and local health systems. The goal: to provide “comprehensive care and support to individuals with chronic and polychronic health conditions,” said chairman and CEO John Standley, “while helping patients “achieve health improvement goals established by their physicians.”

Iowa-based supermarket and pharmacy chain Hy-Vee partnered with the University of Nebraska Medical Center and Ferris State University to offer customers a point-of-care test for influenza and strep. Trained pharmacists administered the tests and filled prescriptions, when needed, under physician-set protocols.

As a focus of its expanding pharmacy practice model, Walgreens Boots Alliance is moving pharmacists out from behind the counter to better counsel patients and expand clinical services, in line with its “Well Experience” store concept.

CVS Health continues to expand its Pharmacy Advisor program. “Pharmacy Advisor helps our PBM plan members with chronic conditions, such as diabetes and high blood pressure, by promoting medication adherence and closing gaps in care,” said CVS Caremark EVP and chief medical officer Troyen Brennan. “Our interventions can also include reaching out directly to their doctors or referring patients to disease management programs.”

Minnesota-based drug chain Thrifty White has enrolled thousands of patients to its synchronized monthly prescription refill system. By doing so, the chain is shifting those patients to appointment-based pharmacy care.

In Hawaii, pharmacists collaborate with inpatient hospital caregivers to provide a seamless transition for discharged patients back into the community. The program, called “Pharm2Pharm,” was created to prevent gaps in care, provide continuity in patients’ long-term treatment and wellness programs, and reduce hospital readmissions.

Teamwork: The new health paradigm

This dramatic evolution in pharmacy practice begins in pharmacy school, where six-year PharmD degree candidates undergo intensive training not only in chemistry, biology and the complex science of medication therapy but, more and more, in the hands-on care and management of patients and chronic disease.

“Pharmacy education focuses to prepare future pharmacists to provide medication-related care directly to patients where and when they need the care. The care is … conducted in collaboration with the patient’s healthcare team with the goal to assist the patient in achieving their healthcare goals,” explains Melissa McGivney, associate professor of pharmacy and therapeutics at the University of Pittsburgh School of Pharmacy and director of Pitt’s Community Pharmacy Residency Program.

For instance, said McGivney, “Our students begin seeing standardized patients by week six of the curriculum — and by the second semester, they are in the community meeting with people who have medication-related needs.”

This team-oriented, outcomes-focused approach to patient health is deeply embedded in modern pharmacy practice, agreed Ronald Jordan, dean of the Chapman University School of Pharmacy in Irvine, Calif. “As health care evolves and communities become more aware and responsible for community health needs, pharmacists as the most accessible healthcare expert are superbly prepared to assist other healthcare team members and organizations in enhancing health and welfare of communities,” Jordan said.

What’s more, “As the most frequently encountered form of medical therapy, medication, especially if properly managed by a pharmacist, is probably the single biggest determinant of improving longevity and public health worldwide,” Jordan added.

For pharmacy patient care, reports reflect real life

A new report by the National Governors Association (NGA) is symbolic of the growing recognition of pharmacy’s vital role in healthcare delivery. The report also makes several key points about what it will take to leverage pharmacy’s value for the benefit of patients across the nation.

“The Expanding Role of Pharmacists in a Transformed Health Care System” — which NGA released in January — does a really nice job of describing the extensive and evolving professional education of pharmacists. It notes that “health care experts increasingly agree that including pharmacists on chronic care delivery teams can improve care and reduce the costs of treating chronic illnesses.”

Directly related to the discussions that will take place during the 2015 NACDS RxIMPACT Day on Capitol Hill, the NGA report emphasized the importance of consistent government policies regarding pharmacy patient care; the need to formally recognize pharmacists as providers, as appropriate; and opportunities to leverage technology to foster collaboration between physicians, pharmacists and other members of a patient’s health team.

The observations of the NGA report build on a steady stream of recognition and recommendations that focus on the powerful role that pharmacy plays in improving and saving lives. The Congressional Budget Office has formally stated that better use of medications can generate cost savings by easing the reliance on costly forms of care. Senior officials at the Centers for Medicare and Medicaid Services have commented on the cost savings that result from better medication adherence — that is, patients taking their medications as prescribed, often as a result of face-to-face counseling with pharmacists. Several studies published in authoritative journals like Health Affairs back that up.

The simple point is that focusing on pharmacy can benefit patients and our nation alike. More and more decision-makers and policy-makers are talking about that, and acting on it. NACDS appreciates this opportunity to continue this discussion with members of Congress this week.

As part of a panel at the recent Drug Store News Industry Issues Summit, officials from Walmart and Kroger shared the ways the two organizations go about taking a collaborative approach to health care.

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